PVS

Question 1

Pulsus parvus? Condition?

Answer 1

Small/weak

Decrease cardiac output

Question 2

Pulsus parvus et tardus? Condition?

Answer 2

Weak and delayed pulse

Aortic stenosis

Question 3

Bounding pulse? Condition?

Answer 3

• Increased pulse pressure
• Rapid, brief peak

↑ stroke volume:
Aortic regurgitation, bradycardia, AV fistulas

Question 4

Pulsus alternans?

Answer 4

Variation in pulse amplitude occurring with alternate beats due to changing systolic pressure

Left ventricular failure

Question 5

Pulsus bigeminus?

Answer 5

Two beats occur in rapid succession, followed by a pause (normal beat alternating with a premature contraction)

Premature ventricular contractions

Question 6

Bisferiens pulse?

Answer 6

Two palpable peaks

Hypertrophic obstructive cardiomyopathy

Question 7

Pulsus paradoxus?

Conditions?

Answer 7

A drop in systolic pressure > 10 mm Hg on inspiration

COPD exacerbations, acute cardiac tamponade, constrictive pericarditis, obstructive sleep apnea

Question 8

ALLEN TEST

Answer 8

• when suspecting arterial insufficiency in the arm or hand

- to ensure patency of the ulnar artery before puncturing the radial artery for blood samples

Question 9

Drains the superficial portions of the lower abdomen and buttocks, the external genitalia

Answer 9

Horizontal group

Question 10

Drains the corresponding area for the great saphenous vein

Answer 10

Vertical group

Question 11

risk factors for PAD (7)

Answer 11

Risk Factors:  
smoking
hypertension
hyperlipidemia
family history
renal disease
diabetes
hyperhomocysteinemia

Question 12

Ask the patient to sit up with legs dangling down. Compare both feet, noting the time required for:
Return of pinkness to the skin (<10 sec)
Filling of the veins of the feet and ankles (15 sec)

3. Look for any unusual rubor (dusky redness) to replace the pallor.

Answer 12

Postural Changes Test

Question 13

Best initial (or screening) test for PAD

Answer 13

ABI index

Question 14

Best initial imaging test

Answer 14

Duplex Doppler ultrasound

Question 15

Acute Limb Ischemia

Answer 15

Ischemia: deficient arterial blood supply due to occlusion

Causes: sudden embolism or thrombosis (most common)
graft/ angioplasty occlusion
Trauma

Pre-existing CAD/PAD (+ previous history of claudication)

Clinical finding: of pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia

Question 16

Chronic Arterial Insufficiency

Answer 16

Pain: Intermittent claudication –> rest pain
Color: Pallor on elevation; dusky red on dependency
Skin changes: Thin, shiny, atrophic skin; hair loss; thickened & ridged nails
Ulceration: If present, involves toes or points of trauma on feet
Pulses: Decreased or absent
Temperature: Cool
ABI < 0.9

Question 17

> 1.40

Answer 17

non-compressible

Question 18

1.00-1.40

Answer 18

normal

Question 19

.91-.99

Answer 19

borderline

Answer 20

abnormal

Question 21

Aortoiliac Occlusive Disease (AIOD) AKA Leriche Syndrome

Answer 21

HISTORY & PE
Claudication of calf muscles, then thigh, hip and buttocks
Impotence/ erectile dysfunction
Diminished/ absent femoral, popliteal and pedal pulses bilaterally

Imaging
Same as for PAD

Question 22

HX
• Asymptomatic (most)
• Sx of compression, erosion: chest pain, dyspnea, cough, hoarseness, dysphagia
• Sx of aortic regurgitation

PE
•Unremarkable
•AR murmur
•Marfan features

Answer 22

Unruptured THORACIC AORTIC ANEURYSM

Question 23

HX
Acute, ripping chest pain radiating to the back
Dyspnea

PE
Hypotension, tachycardia
Acute AR murmur
Shock

Answer 23

Dissecting/ ruptured THORACIC AORTIC ANEURYSM

Question 24

Abdominal ultrasound is for ?

Answer 24

Screening!

Indications
F: age 65- 75y who have ever smoked
M: age 65–75 y who have smoked at least 100 cigarettes in their lifetime
(+) FHx of AAA

Question 25

CT or MRI with contrast ?

Answer 25

to determine the location and size of abdominal aortic aneurysms

Question 26

M: F is 3:1 Young (<40 year old) Smoking is the strongest risk factor

Answer 26

Thromboangiitis Obliterans

Question 27

Thromboangiitis Obliterans DX ?

Answer 27

Arteriogram (smooth tapering lesions in distal vessels; corkscrew collaterals)

Question 28

Usually women <30 Symmetric episodic attacks No tissue injury Negative ESR, ANA, C3 & C4

Answer 28

Primary Raynaud’s phenomenon

Question 29

``` Age > 40, M>F Systemic symptoms Asymmetric attacks Tissue injury or digital ulcers -uncommon Abnormal nailfold capillaroscopy* ```

Answer 29

Secondary Raynaud’s phenomenon

Question 30

Cold stimulation test is used in ?

Answer 30

Raynaud ‘s Phenomenon

Question 31

Compression of the popliteal artery by the gastrocnemius or popliteus muscle Young, athletic men and women (M>F), usually <30 yo A congenital (3%) or acquired condition Hx: Intermittent, exercise-induced, unilateral claudication PE: Normal; may have diminished pulse on ankle dorsi/plantarflexion

Answer 31

Popliteal Artery Entrapment Syndrome

Question 32

``` 50% are bilateral Associated with aneurysm of the aorta SSx pulsatile mass limb ischemia secondary to thrombosis or embolism ```

Answer 32

Popliteal artery aneurysm

Question 33

DDx to Popliteal artery aneurysm?

Answer 33

Baker’s cyst Non-pulsatile mass Knee pain, stiffness, swelling Aggravated by prolonged standing, not relieved by rest

Question 34

Venous Disease risk factors ? (4)

Answer 34

Female gender Obesity Pregnancy Virchow’s triad Hypercoagulability: malignancy, pregnancy, use of estrogen Endothelial injury : trauma, surgery Venous stasis: immobility (long trips, bed rest)

Question 35

Chronic venous insufficiency s/s:

Answer 35

Hyperpigmentation Stasis dermatitis Ulcers (medial malleolus)

Question 36

``` SSx: Leg pain Aching, burning provoked by standing, relieved by elevation dilated tortuous bluish-green veins ```

Answer 36

Varicose Veins

Question 37

Thrombosis and inflammation, usually of the great saphenous vein Epidemiology: F > M Location: LE > US; sites of trauma (IV catheters) Risk factors: Virchow’s triad ``` SSx leg pain + fever erythema, tenderness, induration (“nodular cord”) along the course of a vein swelling ```

Answer 37

Superficial Thrombophlebitis

Question 38

Imaging: Duplex ultrasound Findings: lack of compressibility of vein; impaired blood flow

Answer 38

Superficial Thrombophlebitis